慢性神经性疼痛的药物治疗管理：对加拿大疼痛学会共识声明的回顾。
Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement.
机构信息
Anesthesiologist in the Pain Research Unit in the Department of Anesthesia at the Toronto General Hospital in Ontario.
General practitioner practising in Toronto.
出版信息
Can Fam Physician. 2017 Nov;63(11):844-852.
Abstract
OBJECTIVE
To provide family physicians with a practical clinical summary of the Canadian Pain Society (CPS) revised consensus statement on the pharmacologic management of neuropathic pain.
QUALITY OF EVIDENCE
A multidisciplinary interest group within the CPS conducted a systematic review of the literature on the current treatments of neuropathic pain in drafting the revised consensus statement.
MAIN MESSAGE
Gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors are the first-line agents for treating neuropathic pain. Tramadol and other opioids are recommended as second-line agents, while cannabinoids are newly recommended as third-line agents. Other anticonvulsants, methadone, tapentadol, topical lidocaine, and botulinum toxin are recommended as fourth-line agents.
CONCLUSION
Many pharmacologic analgesics exist for the treatment of neuropathic pain. Through evidence-based recommendations, the CPS revised consensus statement helps guide family physicians in the management of patients with neuropathic pain.
摘要
目的
为家庭医生提供加拿大疼痛学会（CPS）修订的神经病理性疼痛药物治疗共识声明的实用临床总结。
证据质量
CPS 内的一个多学科利益小组在起草修订的共识声明时，对神经病理性疼痛的当前治疗方法进行了系统的文献回顾。
主要信息
加巴喷丁类、三环类抗抑郁药和 5-羟色胺-去甲肾上腺素再摄取抑制剂是治疗神经病理性疼痛的一线药物。曲马多和其他阿片类药物被推荐为二线药物，而大麻素被新推荐为三线药物。其他抗惊厥药、美沙酮、他喷他多、局部利多卡因和肉毒杆菌毒素被推荐为四线药物。
结论
有许多药物镇痛剂可用于治疗神经病理性疼痛。通过循证推荐，CPS 修订的共识声明有助于指导家庭医生管理神经病理性疼痛患者。
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Pain. 2016 Mar;157(3):577-584. doi: 10.1097/j.pain.0000000000000406.
2
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J Pain Res. 2015 Oct 12;8:695-702. doi: 10.2147/JPR.S91924. eCollection 2015.
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Can J Anaesth. 2016 Mar;63(3):307-10. doi: 10.1007/s12630-015-0525-6. Epub 2015 Oct 27.
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8
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